|
NEXGEN PRECOAT STEM TIB PLT SZ
|
Facility
|
IP
|
$8,001.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.16 |
| Max. Negotiated Rate |
$7,681.20 |
| Rate for Payer: Aetna Commercial |
$6,160.96
|
| Rate for Payer: Aetna Commercial |
$6,427.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,240.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,511.44
|
| Rate for Payer: Cash Price |
$4,000.62
|
| Rate for Payer: Cash Price |
$4,174.00
|
| Rate for Payer: Cigna Commercial |
$6,641.04
|
| Rate for Payer: Cigna Commercial |
$6,928.84
|
| Rate for Payer: First Health Commercial |
$7,930.60
|
| Rate for Payer: First Health Commercial |
$7,601.19
|
| Rate for Payer: Humana Commercial |
$7,095.80
|
| Rate for Payer: Humana Commercial |
$6,801.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,561.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,845.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,904.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,160.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,504.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,400.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,041.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,346.24
|
| Rate for Payer: Ohio Health Group HMO |
$6,000.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,261.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,600.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,669.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,085.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,587.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.39
|
| Rate for Payer: PHCS Commercial |
$7,681.20
|
| Rate for Payer: PHCS Commercial |
$8,014.08
|
| Rate for Payer: United Healthcare All Payer |
$7,041.10
|
| Rate for Payer: United Healthcare All Payer |
$7,346.24
|
|
|
NEXGEN PROLONG ALL POLY PAT 32
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
NEXGEN PROLONG ALL POLY PAT 32
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
NEXGEN PROLONG ALL POLY PAT 35
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
NEXGEN PROLONG ALL POLY PAT 35
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
NEXGEN PROLONG ALL POLY PAT 38
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
NEXGEN PROLONG ALL POLY PAT 38
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
NEXGEN PROLONG ALL POLY PAT 41
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
NEXGEN PROLONG ALL POLY PAT 41
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
NEXGEN RH ARTSRF PROV14M FEM D
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN RH ARTSRF PROV14M FEM D
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN RH FUL TIB AGMT 10M SZ1
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN RH FUL TIB AGMT 10M SZ1
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
NEXGEN RH KNEE FEM HINGE POST
|
Facility
|
IP
|
$3,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
NEXGEN RH KNEE FEM HINGE POST
|
Facility
|
OP
|
$3,432.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.16 |
| Max. Negotiated Rate |
$3,294.72 |
| Rate for Payer: Aetna Commercial |
$2,642.64
|
| Rate for Payer: Anthem Medicaid |
$1,180.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,676.96
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cigna Commercial |
$2,848.56
|
| Rate for Payer: First Health Commercial |
$3,260.40
|
| Rate for Payer: Humana Commercial |
$2,917.20
|
| Rate for Payer: Humana KY Medicaid |
$1,180.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,192.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,532.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,203.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.92
|
| Rate for Payer: PHCS Commercial |
$3,294.72
|
| Rate for Payer: United Healthcare All Payer |
$3,020.16
|
|
|
NEXGEN RH KNEE FEM MOD BX SZ B
|
Facility
|
OP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem Medicaid |
$2,921.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Humana KY Medicaid |
$2,921.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,950.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,979.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
NEXGEN RH KNEE FEM MOD BX SZ B
|
Facility
|
IP
|
$8,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.22 |
| Max. Negotiated Rate |
$8,154.24 |
| Rate for Payer: Aetna Commercial |
$6,540.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,625.32
|
| Rate for Payer: Cash Price |
$4,247.00
|
| Rate for Payer: Cigna Commercial |
$7,050.02
|
| Rate for Payer: First Health Commercial |
$8,069.30
|
| Rate for Payer: Humana Commercial |
$7,219.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,965.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,268.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,548.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,474.72
|
| Rate for Payer: Ohio Health Group HMO |
$6,370.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,698.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,633.14
|
| Rate for Payer: PHCS Commercial |
$8,154.24
|
| Rate for Payer: United Healthcare All Payer |
$7,474.72
|
|
|
NEXGEN RH KNEE TIB AGMT10M SZ4
|
Facility
|
IP
|
$20,628.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.66 |
| Max. Negotiated Rate |
$19,803.00 |
| Rate for Payer: Aetna Commercial |
$15,883.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,089.93
|
| Rate for Payer: Cash Price |
$10,314.06
|
| Rate for Payer: Cigna Commercial |
$17,121.34
|
| Rate for Payer: First Health Commercial |
$19,596.71
|
| Rate for Payer: Humana Commercial |
$17,533.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,915.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,223.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,188.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,152.75
|
| Rate for Payer: Ohio Health Group HMO |
$15,471.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,125.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,681.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,394.72
|
| Rate for Payer: PHCS Commercial |
$19,803.00
|
| Rate for Payer: United Healthcare All Payer |
$18,152.75
|
|
|
NEXGEN RH KNEE TIB AGMT10M SZ4
|
Facility
|
OP
|
$20,628.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,681.66 |
| Max. Negotiated Rate |
$19,803.00 |
| Rate for Payer: Aetna Commercial |
$15,883.65
|
| Rate for Payer: Anthem Medicaid |
$7,094.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,089.93
|
| Rate for Payer: Cash Price |
$10,314.06
|
| Rate for Payer: Cigna Commercial |
$17,121.34
|
| Rate for Payer: First Health Commercial |
$19,596.71
|
| Rate for Payer: Humana Commercial |
$17,533.90
|
| Rate for Payer: Humana KY Medicaid |
$7,094.01
|
| Rate for Payer: Kentucky WC Medicaid |
$7,166.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$16,915.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,223.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,188.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,236.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,152.75
|
| Rate for Payer: Ohio Health Group HMO |
$15,471.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,125.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,681.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,394.72
|
| Rate for Payer: PHCS Commercial |
$19,803.00
|
| Rate for Payer: United Healthcare All Payer |
$18,152.75
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ2
|
Facility
|
IP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ2
|
Facility
|
OP
|
$3,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$424.32 |
| Max. Negotiated Rate |
$3,133.44 |
| Rate for Payer: Aetna Commercial |
$2,513.28
|
| Rate for Payer: Anthem Medicaid |
$1,122.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,545.92
|
| Rate for Payer: Cash Price |
$1,632.00
|
| Rate for Payer: Cigna Commercial |
$2,709.12
|
| Rate for Payer: First Health Commercial |
$3,100.80
|
| Rate for Payer: Humana Commercial |
$2,774.40
|
| Rate for Payer: Humana KY Medicaid |
$1,122.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,133.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,676.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,408.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$979.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,145.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,448.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$652.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$424.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,011.84
|
| Rate for Payer: PHCS Commercial |
$3,133.44
|
| Rate for Payer: United Healthcare All Payer |
$2,872.32
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ3
|
Facility
|
IP
|
$4,020.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.60 |
| Max. Negotiated Rate |
$3,859.20 |
| Rate for Payer: Aetna Commercial |
$3,095.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,135.60
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$3,336.60
|
| Rate for Payer: First Health Commercial |
$3,819.00
|
| Rate for Payer: Humana Commercial |
$3,417.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,296.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,966.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,537.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,015.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.20
|
| Rate for Payer: PHCS Commercial |
$3,859.20
|
| Rate for Payer: United Healthcare All Payer |
$3,537.60
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ3
|
Facility
|
OP
|
$4,020.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.60 |
| Max. Negotiated Rate |
$3,859.20 |
| Rate for Payer: Aetna Commercial |
$3,095.40
|
| Rate for Payer: Anthem Medicaid |
$1,382.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,135.60
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$3,336.60
|
| Rate for Payer: First Health Commercial |
$3,819.00
|
| Rate for Payer: Humana Commercial |
$3,417.00
|
| Rate for Payer: Humana KY Medicaid |
$1,382.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,396.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,296.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,966.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,410.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,537.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,015.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.20
|
| Rate for Payer: PHCS Commercial |
$3,859.20
|
| Rate for Payer: United Healthcare All Payer |
$3,537.60
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ4
|
Facility
|
OP
|
$4,020.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.60 |
| Max. Negotiated Rate |
$3,859.20 |
| Rate for Payer: Aetna Commercial |
$3,095.40
|
| Rate for Payer: Anthem Medicaid |
$1,382.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,135.60
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$3,336.60
|
| Rate for Payer: First Health Commercial |
$3,819.00
|
| Rate for Payer: Humana Commercial |
$3,417.00
|
| Rate for Payer: Humana KY Medicaid |
$1,382.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,396.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,296.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,966.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,206.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,410.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,537.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,015.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.20
|
| Rate for Payer: PHCS Commercial |
$3,859.20
|
| Rate for Payer: United Healthcare All Payer |
$3,537.60
|
|
|
NEXGEN RH KNEE TIBIAL PLAT SZ4
|
Facility
|
IP
|
$4,020.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.60 |
| Max. Negotiated Rate |
$3,859.20 |
| Rate for Payer: Aetna Commercial |
$3,095.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,135.60
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Cigna Commercial |
$3,336.60
|
| Rate for Payer: First Health Commercial |
$3,819.00
|
| Rate for Payer: Humana Commercial |
$3,417.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,296.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,966.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,206.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,537.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,015.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.20
|
| Rate for Payer: PHCS Commercial |
$3,859.20
|
| Rate for Payer: United Healthcare All Payer |
$3,537.60
|
|
